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Refractory singultus and area postrema syndrome as a presentation of neurocysticercosis
  1. Amlan Kusum Datta1,
  2. Sudeshna Malakar2 and
  3. Adreesh Mukherjee3
  1. 1 Neurology, Narayana Multispeciality Hospital, Barasat, West Bengal, India
  2. 2 Apollo Gleneagles Hospital, Kolkata, West Bengal, India
  3. 3 Neurology, Bangur Institute of Neurosciences, Institute of Post Graduate Medical Education and Research, Kolkata, India
  1. Correspondence to Dr Adreesh Mukherjee; adreesh03{at}yahoo.co.in

Abstract

Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system, caused by the pork tapeworm, Taenia solium. Common presenting features are seizures, headaches and focal neurodeficits. The present report details the anecdote of a middle-aged Asian man, who presented with subacute onset of persistent nausea, vomiting and hiccups. Following unsuccessful trials with numerous prokinetic, antipsychotic, muscle relaxant and anticonvulsant medications, as well as an uneventful battery of gastrointestinal tests, he was referred for neurological evaluation. The constellation of symptoms was congruent with the diagnosis of area postrema syndrome. Although initial CT scan of brain was normal, MRI with contrast evaluation revealed a circumscribed, ring-enhancing lesion of the dorsal medulla oblongata, reminiscent of colloid vesicular stage of NCC. The patient was successfully treated with steroids and albendazole. The association of refractory singultus, nausea and vomiting and NCC is thus far, not reported in the literature.

  • Tropical medicine (infectious disease)
  • Brain stem / cerebellum
  • Infection (neurology)
  • Neuroimaging

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Footnotes

  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: AKD and AM. The following authors gave final approval of the manuscript: AKD, SM and AM.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.